What is the risk of acute kidney disease for head and neck cancer patients treated with cisplatin?
Cisplatin is a key chemotherapy drug for head and neck cancer, but it can damage the kidneys. Acute kidney injury (AKI) is a sudden drop in kidney function. The risk varies based on the dose of cisplatin, other health conditions, and how doctors monitor kidney health. Studies show that between 20% and 69% of patients develop AKI during treatment, depending on the specific regimen and patient risk factors.
What the research says
A 2024 study of 110 head and neck cancer patients treated with high-dose cisplatin (≥200 mg/m² total) and radiotherapy found that 20% developed acute kidney disease (AKD), a broader term that includes AKI 4. Patients with AKD had a much larger rise in serum creatinine (a marker of kidney function) compared to those without AKD 4.
A re-analysis of a phase II/III trial (JCOG1008) involving 251 patients reported a higher AKI rate of 37.5% 9. This study identified four key risk factors: having a primary tumor in the hypopharynx or larynx (versus oral cavity or oropharynx), receiving cisplatin every 3 weeks (versus weekly), low serum albumin (≤3.5 g/dL), and low creatinine clearance (<90 mL/min) 9. The more risk factors a patient had, the higher their chance of AKI 9.
An older study from 2019 found an even higher AKI incidence of 69% among 124 patients treated with high-dose cisplatin (100 mg/m² every 3 weeks) 11. Most of these patients had only one AKI episode, but some had multiple episodes 11. The study also noted that AKI can affect long-term kidney function and treatment outcomes 11.
A 2025 study of 989 patients found that 22.1% developed AKI after platinum-based chemoradiotherapy 10. Patients taking RAAS blockers (a type of blood pressure medication) had a higher AKI risk (38%) compared to non-users (21%) 10. This suggests that certain medications may increase vulnerability to kidney injury during cisplatin treatment 10.
What to ask your doctor
- What is my personal risk of acute kidney injury based on my cisplatin dose schedule (weekly vs. every 3 weeks) and my kidney function?
- Should I have my kidney function checked before, during, and after treatment to monitor for early signs of kidney damage?
- Do my current medications, especially blood pressure drugs like RAAS blockers, affect my risk of kidney injury during cisplatin therapy?
- What are the signs of kidney problems I should watch for, and when should I contact you if I notice them?
- Are there any steps I can take before or during treatment to help protect my kidneys, such as adjusting my diet or hydration?
This question is drawn from common patient questions about Nephrology and answered using cited medical research. We do not provide individualized advice.